Successful combination of remdesivir and convalescent plasma to treat a patient with rituximab-related B-cell deficiency and prolonged COVID-19: A case report

Treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in immuno compromised patients with complete B cell depletion can be really challenging due to the lack of seroconversion and long lasting disease. We describe a case of long-lasting coronavirus disease (COVID-19) in a female patient with rheumatoid arthritis who was treated with rituximab and continued to show B-cell depletion. An ongoing replication of SARS-CoV-2 was demonstrated for a period of 8 months when nasopharyngeal swabs were tested. She was treated once with remdesivir but without lasting resolution, and she was then treated with convalescent plasma but with a similar effect. Only with a combination of both treatments was clinical resolution achieved. The patient's lack of seroconversion and the prolonged course of the disease illustrate the importance of humoral immunity in resolving SARS-CoV-2 infection. This case report highlights challenges in managing immunocompromised hosts, who may act as persistent shedders and sources of transmission. Combination of remdesivir and convalescent plasma resulted successful to achieve clinical resolution of SARS-CoV-2 infection in our patient.